Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm
Objectives: Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up.
Methods: Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models.
Results: Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55).
Conclusions: Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:51 |
|---|---|
| Enthalten in: |
International journal of cardiology. Heart & vasculature - 51(2024) vom: 15. März, Seite 101375 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Zamirpour, Siavash [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Ascending aortic aneurysm |
|---|
| Anmerkungen: |
Date Revised 09.03.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1016/j.ijcha.2024.101375 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM369252519 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM369252519 | ||
| 003 | DE-627 | ||
| 005 | 20240309232407.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240304s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.ijcha.2024.101375 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1321.xml |
| 035 | |a (DE-627)NLM369252519 | ||
| 035 | |a (NLM)38435381 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Zamirpour, Siavash |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Height and body surface area versus wall stress for stratification of mid-term outcomes in ascending aortic aneurysm |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 09.03.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Objectives: Current diameter-based guidelines for ascending thoracic aortic aneurysms (aTAA) do not consistently predict risk of dissection/rupture. ATAA wall stresses may enhance risk stratification independent of diameter. The relation of wall stresses and diameter indexed to height and body surface area (BSA) is unknown. Our objective was to compare aTAA wall stresses with indexed diameters in relation to all-cause mortality at 3.75 years follow-up | ||
| 520 | |a Methods: Finite element analyses were performed in a veteran population with aortas ≥ 4.0 cm. Three-dimensional geometries were reconstructed from computed tomography with models accounting for pre-stress geometries. A fiber-embedded hyperelastic material model was applied to obtain wall stress distributions under systolic pressure. Peak wall stresses were compared across guideline thresholds for diameter/BSA and diameter/height. Hazard ratios for all-cause mortality and surgical aneurysm repair were estimated using cause-specific Cox proportional hazards models | ||
| 520 | |a Results: Of 253 veterans, 54 (21 %) had aneurysm repair at 3.75 years. Indexed diameter alone would have prompted repair at baseline in 17/253 (6.7 %) patients, including only 4/230 (1.7 %) with diameter < 5.5 cm. Peak wall stresses did not significantly differ across guideline thresholds for diameter/BSA (circumferential: p = 0.15; longitudinal: p = 0.18), but did differ for diameter/height (circumferential: p = 0.003; longitudinal: p = 0.048). All-cause mortality was independently associated with peak longitudinal stresses (p = 0.04). Peak longitudinal stresses were best predicted by diameter (c-statistic = 0.66), followed by diameter/height (c-statistic = 0.59), and diameter/BSA (c-statistic = 0.55) | ||
| 520 | |a Conclusions: Diameter/height improved stratification of peak wall stresses compared to diameter/BSA. Peak longitudinal stresses predicted all-cause mortality independent of age and indexed diameter and may aid risk stratification for aTAA adverse events | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Ascending aortic aneurysm | |
| 650 | 4 | |a Biomechanics | |
| 650 | 4 | |a Computed tomography | |
| 650 | 4 | |a Finite element analysis | |
| 650 | 4 | |a Outcomes | |
| 650 | 4 | |a Risk factors | |
| 700 | 1 | |a Xuan, Yue |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Zhongjie |e verfasserin |4 aut | |
| 700 | 1 | |a Gomez, Axel |e verfasserin |4 aut | |
| 700 | 1 | |a Leach, Joseph R |e verfasserin |4 aut | |
| 700 | 1 | |a Mitsouras, Dimitrios |e verfasserin |4 aut | |
| 700 | 1 | |a Saloner, David A |e verfasserin |4 aut | |
| 700 | 1 | |a Guccione, Julius M |e verfasserin |4 aut | |
| 700 | 1 | |a Ge, Liang |e verfasserin |4 aut | |
| 700 | 1 | |a Tseng, Elaine E |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t International journal of cardiology. Heart & vasculature |d 2014 |g 51(2024) vom: 15. März, Seite 101375 |w (DE-627)NLM246683767 |x 2352-9067 |7 nnns |
| 773 | 1 | 8 | |g volume:51 |g year:2024 |g day:15 |g month:03 |g pages:101375 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.ijcha.2024.101375 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 51 |j 2024 |b 15 |c 03 |h 101375 | ||